The Global Challenge

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• The Global Challenge
• Critical health logistics systems are poorly
  maintained, in advanced states of decay or
  altogether absent
  
• Weak managerial skills, poor motivation of staff,
  and unpredictable funding for health services
  
• Lack of reliable fuel prevents proper
  refrigeration, sterilization and lighting in
  clinics
  
• The poor quality of health services and
  unreliable availability of supplies have
  decreased confidence in the health system
  
• Many of the 12 million children not immunized in
  Africa live in remote areas beyond the reach of
  health systems
  
• At least 1.3 million deaths are attributed to
  unsafe injection practices
  
• In Mozambique, less than five percent of rural
  poor uses the public health system for diarrheal
  diseases, a leading cause of death

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• Historical Responses
• Vertical approach to a disease e.g., Polio
  or a family of interventions e.g., GAVI for
  childhood immunization
  
• These efforts effectively mobilize resources to
  solve specific problems but tend to duplicate
  efforts of others
  
• The cost of providing healthcare in remote
  communities is five times greater than in urban
  areas
  
• New strategies are needed to cost effectively
  reach mothers and children in remote communities

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Illustrative Example Vaccines Immunizations
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• VillageReach
• 501(c)(3) non-profit organization that goes the
  last mile to improve access to essential services
  in remote communities
  
• VillageReach was founded in 2000 and has
  assembled a extensive network of partners and
  advisors
  
• Board of Trustees include
• Nelson Mandela, Honorary Chair
• Graca Machel, Chair, Foundation for Community
  Development (FDC)
  
• Dr. Seth Berkeley, CEO, International AIDS
  Vaccine Initiative (IAVI)
  
• Jacques-Francois Martin, President, Vaccine Fund
• Dr. Paul Kleindorfer, Professor, The Wharton
  School of Business
  
• Blaise Judja-Sato, Founder and President

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The VillageReach Model
Sustained Funding
Innovative Partnerships
Local Capacity Ownership
Communication System
Transport System
Energy System
Refrigeration System
Quality Safety
Access to Essential Services in Remote Communities
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The Demonstration Project
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• Demonstration Project Strategic Objectives
• Strengthen the public health system and improve
  access to immunization other healthcare
  services
  
• Empower healthcare workers to concentrate on
  providing health services by freeing them from
  the burdens of logistics activities
  
• Increase confidence in public health systems
  through greater availability of health services
  and participation of community partners
  
• Lower dependency on external funding by covering
  up to 25 of operating costs with profits from
  propane sales within 5 years
  
• Increase the share of local households with
  access to clean burning energy for cooking and
  lighting
  
• Refine the VillageReach Model and create guides
  for replication in other parts of the developing
  world

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• Demonstration Project Situation Analysis
• Cabo Delgado is located 900 miles north of Maputo
  and has 1.5 million inhabitants with one of the
  lowest per capita incomes in Mozambique
  
• All of the 90 clinics experienced frequent
  stock-outs of critical vaccines, medicines, fuel,
  and spare parts for equipment
  
• Clinics dont have access to energy source to
  properly refrigerate vaccines, sterilize
  syringes, and provide lighting for nighttime
  emergencies
• Overworked and poorly trained health workers
  spend up to 50 of their time on logistics and
  equipment maintenance
  
• 45 of the population leaves more than 10 km from
  the nearest clinic. Lack of communications and
  transport significantly undermines outreach and
  supervision activities
• Less than 6 of the population has access to
  electricity. Mangroves are now widely harvested
  for fuel, endangering the local commercial
  fishing industry, one of the main sources of
  income

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• Demonstration Project Progress to Date
• Launched in March 2002, the project currently
  covers 42 clinics in seven districts serving more
  than 900,000 people
  
• Installed a dependable cold chain five large
  capacity refrigerators at the provincial store
  and propane-powered refrigerators in 30 clinics
  
• Built a reliable logistics system a dedicated
  fleet performs monthly deliveries of vaccines,
  medical supplies, and propane to participating
  clinics
• Enhanced lighting services in clinics installed
  propane-powered lamps
  
• Improved safety of injections provided
  propane-powered burners and incorporating needle
  removers to facilitate disposal of Auto-Disable
  syringes
• Trained more than 100 health workers and local
  staff to properly operate and maintain equipment
  installed in clinics
  
• Provided health workers with transportation and
  communication to improve outreach and provide
  emergency care

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Demonstration Project Progress to Date

• Established VidaGas, a propane distribution
  company, to ensure reliable availability of clean
  energy in Cabo Delgado
  
• We supply about five tons of propane a month to
  clinics, households and businesses. Profits will
  fund logistics system, helping to ensure
  long-term sustainability
• We are currently working with the Mozambique
  Government and Energy Fund to improve access to
  clean energy by introducing
  
• fuel subsidies for low-income households
• micro-lending programs
• affordable domestic appliances
• We have created employment opportunities and
  helped set up three independent propane retailers

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• Next Steps
• Short-Term Refine the Model
• Strengthen and expand the system to reach 90
  clinics serving 1.5 million people in Cabo
  Delgado
  
• Interim evaluation and model refinement
• Expand the system to reach 130 clinics serving
  3.5 million people into the neighboring province
  of Nampula
  
• Final evaluation, model completion, and finding
  dissemination
  
• Long-Term Roll out the Model
• In Mozambique and other parts of the developing
  world

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VidaGas Solutions for Health

• Propane is a safe, cost-effective, and
  environmentally-friendly alternative to
  traditionally-used kerosene and biomass fuels.
  VidaGas provides clinics with
• propane-powered refrigerators that are highly
  efficient
  
• lamps that provide bright, consistent clinic
  lighting for nighttime emergencies
  
• steam sterilizers that ensure safe injection
  practices

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Refrigeration System
Issue Cold chains are in advanced state of
decay. Old kerosene-powered refrigerators have
frequent outages due to lack of fuel and spare p
arts. As a result, temperature-sensitive vaccines
become ineffective. Our Solution We introduce
d new propane (LPG) powered refrigerators in
remote health facilities. These refrigerators are
highly efficient and reliable, and have low
temperature variability. We also trained health
staff in regular operations and maintenance
procedures.
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Unsafe Injection
Issue Unsafe injections can result in the
transmission of blood-borne pathogens from
patient-to-patient, and from patient-to-health
worker. The community is at risk when injection
equipment is not safely disposed.
Our Solution We introduced injection safety and
waste disposal tools, technologies and best
practices. We have also provided propane burners
for steam sterilizers that ensure safe injection
practices in areas with limited access to
disposable syringes.
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Maternal and Child Health
Issue Childbirth is an unpredictable event,
occurring anytime day or night. In areas without
electricity, deliveries can be difficult by the
flickering light of a torch or kerosene lamp. The
majority of women deliver their babies at home
under unhygienic conditions without trained
assistance. Our Solution We installed new prop
ane-powered lamps in health facilities to provide
bright, uninterrupted light for nighttime
childbirth. We deliver birthing kits to clinics
and traditional birth attendants to ensure
sterilized conditions.
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VidaGas Solutions for Households
Issue In many areas, women and children spend
many hours collecting firewood. In addition to
posing a significant threat to the local
environment, cooking over an open flame is
associated with long-term respiratory illness.
Our Solution VidaGas promotes the use of small
propane cookers for household use. The equipment
is provided at a low initial investment through
micro-lending programs.